“Diffusion is essentially a social process through which people talking to people spread an innovation.”
In our era of electronic communications, we’ve come to expect that important innovations will spread quickly. Plenty do: think of in-vitro fertilization, genomics, and communications technologies themselves. But there’s an equally long list of vital innovations that have failed to catch on. The puzzle is why.
When it comes to medicine, there have been many new approaches that have caught on like wildfire—like the mid-1800s process of using ether as a precursor to anesthesiology and leading to antiseptic. For practices that have caught on, there are just as many that have failed miserably to catch.
The most common approach to changing behavior is to say to people, “Please do X.” Please warm the newborn. Please wash your hands. Please follow through on the twenty-seven other childbirth practices that you’re not doing. This is what we say in the classroom, in instructional videos, and in public-service campaigns, and it works, but only up to a point.
Then, there’s the law-and-order approach: “You must do X.” We establish standards and regulations, and threaten to punish failures with fines, suspensions, the revocation of licenses. Punishment can work.
Often, we offer incentives rather than penalties. If you do this, then we will give you X, Y, and Z.
But to create new norms, you have to understand people’s existing norms and barriers to change. You have to understand what’s getting in their way.
In the era of the iPhone, Facebook, and Twitter, we’ve become enamored [with] ideas that spread as effortlessly as ether [did in the 1800s]. We want frictionless, “turnkey” solutions to the major difficulties of the world—hunger, disease, poverty. We prefer instructional videos to teachers, drones to troops, incentives to institutions. People and institutions can feel messy and anachronistic. They introduce, as the engineers put it, uncontrolled variability.
But technology and incentive programs are not enough. “Diffusion is essentially a social process through which people talking to people spread an innovation,” wrote Everett Rogers, the great scholar of how new ideas are communicated and spread. Mass media can introduce a new idea to people. But, Rogers showed, people follow the lead of other people they know and trust when they decide whether to take it up. Every change requires effort, and the decision to make that effort is a social process.
This is something that salespeople understand well. I once asked a pharmaceutical rep how he persuaded doctors—who are notoriously stubborn—to adopt a new medicine. Evidence is not remotely enough, he said, however strong a case you may have. You must also apply “the rule of seven touches.” Personally “touch” the doctors seven times, and they will come to know you; if they know you, they might trust you; and, if they trust you, they will change. That’s why he stocked doctors’ closets with free drug samples in person. Then he could poke his head around the corner and ask, “So how did your daughter Debbie’s soccer game go?” Eventually, this can become “Have you seen this study on our new drug? How about giving it a try?” As the rep had recognized, human interaction is the key force in overcoming resistance and speeding change.
People talking to people is still how the world’s standards change.
Recently, cholera was slowed and its affects abated heavily in Bangladesh. During the early 1900s, a sugar and salt solution was discovered that, if mixed properly, could eradicate and stop cholera from dehydrating its victims and defeat the disease. It was a solution that could easily be prepared in someone's own kitchen and it prevented nearly 97% of people from dying of dehydration.
But it didn't catch on, very few people even know about it today. To understand why, you have to imagine having a child throwing up and pouring out diarrhea like you've never seen before. Making her drink seems only to provoke more vomiting. Chasing the emesis and the diarrhea seems both tortuous and futile. Many people's natural inclination is to not feed the child anything.
Furthermore, why believe that this particular mixture of sugar and salt would be any different from water or anything else you might have tried? And it is particular. Throw the salt concentration off by just a couple of teaspoons and the electrolyte imbalance could be dangerous. The child must also keep drinking the stuff even after she feels better, for as long as the diarrhea lasts, which is up to five days. Nurses routinely got these steps wrong. Why would villagers do any better?
A decade after this remarkable cholera healer was discovered, the idea remained completely stalled. Nothing much had changed. Diarrheal disease remained the world's biggest killer of children under the age of five.
In 1980, however, a non-profit organization in Bangladesh produced a book called "A Simple Solution," deployed a door to door, person by person, talking campaign. They just educated people through sheer determination of having conversations.
The logistics were daunting—trying to reach thousands of people through talking. They had a team of women, a cook, and a supervisor and went village to village, cooking the solution, educating and conversing along the way with anyone and everyone who would listen.
Coaxing villagers to make the solution with their own hands and explain the messages in their own words, while a trainer observed and guided them, achieved far more than any public-service ad or instructional video could have done.
Three decades later, national surveys have found that almost 90% of children with severe diarrhea were given the solution. Child deaths from diarrhea plummeted more than eighty per cent between 1980 and 2005.
Often times the solution to spreading your idea, your company, or your product is not a creative ad campaign, or a flashy business card, but it's the sheer determination it takes to go door-to-door, kitchen-to-kitchen, and get to know the customers you aim to serve. This process alone will set you apart from the rest and position you as one of them in the tribe.
Don't chase the viral ideas in the wind. Choose to deliberately knock on the right doors.
You can read the full and quite lengthy article from Atul Gawande in The New Yorker.
(photo via wystan)